CMV encephalitis in an immune-competent patient.

After being admitted to hospital with atypical chest pain, a 61-year-old woman was noted to become lethargic and confused. She also developed global dysphasia. MRI was suggestive of encephalitis, and lumbar puncture was positive for cytomegalovirus (CMV) PCR. The patient was treated with intravenous ganciclovir and subsequent oral valganciclovir and she gradually made a reasonable recovery. While this infection is usually closely linked to immunosuppression, the patient was found to be HIV negative, and was not on any immunosuppressive therapy. Going through the patient's medical history revealed two possible risk factors which might have led to the development of CMV encephalitis: immunosuppression secondary to underlying poorly controlled diabetes mellitus; and previous admission to the intensive care unit which might have lead to CMV reactivation.

An Adult Case of Acute EBV Cerebellitis.

Acute neurological manifestations of infectious mononucleosis are uncommon and have been predominantly reported in the paediatric population. We report a case of acute Epstein-Barr virus cerebellitis in an adult in whom spontaneous resolution of symptoms and signs occurred after 2 weeks of supportive treatment. An infective cause for an acute cerebellar syndrome in an adult must always be considered in the differential diagnosis when appropriate. LEARNING POINTS: A high index of suspicion is needed in adults who present with a febrile syndrome and cerebellar signs.An acute cerebellar syndrome may be the only manifestation of Epstein-Barr virus infection.In certain cases, conservative management may be sufficient depending on the clinical severity.

Nephrolithiasis, stone composition, meteorology, and seasons in Malta: Is there any connection?

CONTEXT: The effect of seasons and meteorology on the incidence of nephrolithiasis has been studied in various regions around the globe, but seldom in the Mediterranean. AIMS: This retrospective analysis aims at investigating these putative effects in the Maltese Islands, whose climate is typically Mediterranean, followed by a systematic review of the literature. MATERIALS AND METHODS: Submission rate and chemical composition of all kidney stones after spontaneous passage or surgical removal between January 2009 and December 2011 were analyzed according to seasons and corresponding meteorology. RESULTS: A total of 389 stones were analyzed. A higher stone submission rate was observed in summer compared to winter (31.6% vs. 20.8%, P = 0.0008) and in the warm period compared to the cold period (57.1% vs. 42.9%, P = 0.0001). Significant correlation was established between the monthly number of stones and mean monthly maximum temperature (r = 0.50, P = 0.002), mean monthly temperature (r = 0.49, P = 0.003) and mean monthly Humidex (r = 0.49, P = 0.007). Humidex was found to be an independent predictor for stone submission (ß = 0.49, P = 0.007). The majority of stones contained calcium (83.3%), combined with oxalate (77.6%), phosphate (14.7%), and carbonate (2.8%). Some stones (11.8%) contained a mixture of >1 negatively charged molecules. Urate (11.6%), cysteine (4.6%), and ammonium-magnesium-phosphate (0.5%) constituted the rest. There was no association between chemical composition and seasons. Literature review included 25 articles. Higher ambient temperature and warm seasons were the most commonly encountered risk factors for both presentation and etiology of nephrolithiasis. CONCLUSIONS: A significant positive correlation was noted between ambient temperature and stone submission rate, which was significantly higher during the warm months in Malta.